I-3-9-50.Control of Potential Court Cases

Last Update: 9/08/05 (Transmittal I-3-36)

Under the law and regulations, a party who disagrees with an Appeals Council decision, or with the ALJ's decision if the request for review is denied, may obtain a review of the decision by commencing a civil action in a Federal district court within 60 days after the claimant receives notice of the Council's action, or within such further time as the Council may allow (20 CFR 404.981, 404.982, 416.1481, 416.1482, and sections 205(g) and 1631(c)(3) of the Social Security Act). The Council's notice advises the parties that the Council's action is presumed to be received within five days after the date of the notice unless a reasonable showing is otherwise made.

After the Appeals Council issues an unfavorable decision or denies or dismisses a request for review, the claim file is retained in the OAO branch mini-docket for 150 days (180 days for claimants residing in Puerto Rico). If a civil action is filed, the claim file can be quickly retrieved, thereby enabling the Commissioner to file a timely answer to the complaint. Although the regulations do not provide a right to court review with respect to Appeals Council dismissals or denials of requests for review of ALJ dismissals, the Commissioner must, nevertheless, respond to the complaint if a civil action is filed. Therefore, claim files with these actions are also held.

NOTE:

In the 11th Circuit, the notice of an Appeals Council dismissal of a request for review of an ALJ's decision provides a right to court review in accordance with Acquiescence Ruling 92-4(11)).

To clearly identify all potential court cases, the support staff will attach a Potential Court Case flag (form SSA-28) to each claim file when the Appeals Council denies or dismisses a request for review or issues a denial decision. The support staff will insert a release date on the form for 150 days after the Council's action (180 days after the Council's action for claimants residing in Puerto Rico).

Requests for release of the claim file outside Central Office during the 150 or 180 day holding period for civil actions will be referred to the appropriate OAO branch. If the branch releases a claim file outside OHA Headquarters during the holding period, the branch must carefully document the location of the folder, including the name and telephone number of the individual to whom it was sent, so the file can be retrieved quickly in the event the claimant files a civil action.

NOTE:

In addition, Branch Chief concurrence is needed in order to release a file to a component outside Central Office if the holding period for filing a civil action has not yet expired. In doing so, ensure that appropriate action is taken to code the case to its proper location.